PGY-3 Goals & Objectives

 

(in addition to PGY-2 Level goals)

Medical Knowledge

  • To describe and perform the most advanced strabismus examination techniques (e.g., complicated prism cover testing in multiple cranial neuropathy, patients with nystagmus, dissociated vertical deviation, double Maddox rod testing).
  • To perform the most advanced techniques for assessment of visual development in complicated or non-cooperative pediatric ophthalmology patients (e.g., less common objective measures of visual acuity, electrophysiologic testing).
  • To apply the most advanced knowledge of strabismus anatomy and physiology (e.g., spiral of Tillaux, secondary and tertiary actions, spread of comitance) in evaluation of patients.
  • To describe clinical application of the most advanced sensory adaptations (e.g., anomalous head position, anomalous retinal correspondence).
  • To recognize and treat the most complicated etiologies of amblyopia (e.g., refraction noncompliance, patching failures, pharmacologic penalization).
  • To recognize and treat the most complex etiologies of esotropia (e.g., optical, prism-induced, postsurgical/consecutive).
  • To recognize and treat the most complex etiologies of exotropia (e.g., supranuclear, paralytic pontine exotropia, consecutive).
  • To recognize and treat the most complex strabismus patterns (e.g., aberrant regeneration, postsurgical, thyroid ophthalmopathy and myasthenia gravis).
  • To recognize and treat the most complex etiologies of vertical strabismus (e.g, skew deviation, postsurgical, restrictive).
  • To apply non-surgical treatment (e.g., patching, atropine penalization) of more complicated forms of amblyopia (e.g., non-compliant, patching failures).
  • To recognize, evaluate, and treat the most complex forms of childhood nystagmus (e.g., sensory, spasmus nutans, associated with neurologic or systemic disease).
  • To recognize and treat (or refer for treatment) complex retinopathy of prematurity (e.g., stages, treatment indications, retinal detachment).
  • To recognize and treat (or refer for treatment) uncommon etiologies and types of pediatric cataracts (e.g., congenital, traumatic).
  • To recognize and appropriately evaluate the more complex hereditary ocular syndromes (e.g., bilateral Duane syndrome, Mobius syndrome).
  • To recognize and treat (or refer for treatment) patients with complicated retinoblastoma (e.g., bilateral cases, monocular patient, treatment failure, pineal involvement).
  • To recognize and evaluate the less common congenital ocular anomalies (e.g., unusual genetic syndromes).
  • To apply the most advanced principles of binocular vision and amblyopia (e.g., physiology of binocular vision, diplopia, confusion and suppression, normal and abnormal retinal correspondence, classification and characteristics of amblyopia).
  • To recognize and treat complex pediatric retinal disease (e.g., inherited retinopathies, retinopathy of prematurity).
  • To recognize and treat complex pediatric glaucoma.
  • To recognize and treat complex pediatric cataracts and anterior segment abnormalities (including surgical implications, techniques, and complications).
  • To recognize and treat complex pediatric eyelid disorders (e.g., lid lacerations, lid tumors).
  • To recognize and treat (or refer) pediatric orbital disease (e.g., orbital tumors, orbital fractures, rhabdomyosarcoma, severe congenital orbital malformations).
     

Patient Care

  • To perform a more advanced extraocular muscle examination based on knowledge of the anatomy and physiology of ocular motility.
  • To assess more advanced ocular motility problems (e.g., bilateral or multiple cranial neuropathy, myasthenia gravis, thyroid eye disease).
  • To apply Hering’s and Sherrington’s laws in more advanced cases (e.g., pseudoparesis of the contralateral antagonist, enhancement of ptosis in myasthenia gravis)
  • To perform more advanced measurements of strabismus (e.g., double Maddox rod testing, Lancaster red green testing, synoptophore or amblyoscope).
  • To perform assessment of vision in more difficult strabismus patients (e.g, uncooperative child, mentally impaired, nonverbal or preverbal).
  • To perform basic extraocular muscle surgery
    • To exercise surgical judgement for the indications and contraindications for strabismus surgery
    • To perform pre-operative assessment, intraoperative techniques and to describe intraoperative and post-operative complications of strabismus surgery
    • To perform the following strabismus surgeries
      • Recession
      • Resection
      • Muscle weakening (e.g., tenotomy) and strengthening (e.g., tuck) procedures
      • Transposition
      • Use of adjustable sutures
    • To manage the complications of strabismus surgery (e.g., slipped muscle, anterior segment ischemia).